NURS 3444 Module 6

a loss of structure and function

impairment

individual who requires assistance for disabilities that may be medical, mental, or psychologic

special needs

Nursing care of child and family with down syndrome

- support at time of diagnosis and after - assist with physical problems (feeding, decreased tone, promote respiratory health) - prenatal/genetic counseling

Child behavior indicators of sexual abuse

- unwilling to change clothes - withdrawn or infantile behavior - sophisticated knowledge of sexual behavior - abruptly develops ED - performs self-destructive behavior - masturbates excessively - won't talk about abuse

Respiratory illness and Down Syndrome

Children with Down Syndrome are susceptible to respiratory illness and are candidates for immunoglobulin during flu season

Nontraditional

Does not follow typical pattern

What should be suspected when normal health child sudden deteriorates without a known cause

Toxic ingestion

Compensated shock

Poor perfusion exists without decrease in BP

Tertiary prevention of cognitive impairment

Treatment to minimize long-term consequences Early ID of therapies and rehab services

Sexual abuse

USe, persuasion, por coercion of any child to engage in sexually explicit conduct

Treatment for submersion injury

Suction - oxygen at 100% - insert OG and NG tube to decompress stomach and prevent aspiration of stomach contents - initiate chest compressions if no pulse - treat hypothermia slowly

When to do chest compressions on child?

When there is no pulse OR HR <60 (not really for adolescents)

long lasting or recurrent condition that interferes with daily functioning and persists for > 3 months.

chronic illness

When caring for a child newly diagnosed with special needs, which nursing action is priority? a.) Setting up respite care for the caregivers. b.) Explaining the diagnosis to the caregivers. c.) Providing resources for the family. d.) Answering the caregiver's questions.

d.) Answering the caregiver's questions.

AFP and Down Syndrome

decreased AFP can indicate Down Syndrome

a result of an impairment that could be physical, cognitive, mental, sensory, emotional developmental, or a combination of these

disability

Compensated SVT

Child is alert, breathing and well perfused Treatment: vagal maneuvers - ice on face - blow through obstructed straw - adenosine if vagal maneuver fails

Pediatric chain of survival

1. prevention of cardiac arrest and injury (big distinction from adult chain) 2. early CPR 3. early access to emergency response system 4. early advanced care (PALS) 5. integrated post-cardiac arrest care

A nurse correctly identifies which data as needing to be obtained from an injured child in relation to his or her respiratory status? Select all that apply. a.) Skin color b.) Quality of respirations c.) Sound of obstruction d.) Pulse rate e.) Rate of respirations

a.) Skin color b.) Quality of respirations c.) Sound of obstruction e.) Rate of respirations

A child, accompanied by a parent, is brought to the emergency department after sustaining an injury from a fall. The nurse is assessing the child. Which question is important for the nurse to ask the parent first? a.) "Did your child lose consciousness?" b.) "What time did the injury occur?" c.) "How did your child get hurt?" d.) "Does your child have any allergies?"

c.) "How did your child get hurt?"

The nurse has administered IV adenosine as prescribed to a child with supraventricular tachycardia. Which action would the nurse do next? a.) Set up a continuous infusion for administration of adenosine. b.) Give five positive-pressure ventilations. c.) Administer a rapid, generous saline flush. d.) Monitor for ventricular arrhythmias.

c.) Administer a rapid, generous saline flush.

Resources for child with special needs

- educational opportunities - financial resources - respite care - complementary therapies

Child behavioral indicators of physical abuse

- emotional extremes - repetitive behaviors - no apparent parents affection - suicidal ideation

Examples of x-linked recessive genetic disorders

- hemophilia - color blindness - Duchenne muscular dystrophy

Physical indicators of neglect

- inadequate weight gain - poor growth pattern - constant hunger - poor hygiene or obsession with cleanliness - untreated illness - inappropriate attire for the weather - adult behavior

A child has been diagnosed with medical abuse by his mother. When setting goals, which goal is highest priority? a.) obtaining treatment for the mother b.) establishing the safety of the child c.) psychotherapy for the unaffected children in the family d.) therapy for the child

b.) establishing the safety of the child

Uncompensated SVT

Change in consciousness, respiratory status, and perfusion - emergent intervention needed - adenosine

Neuro exam in children

Evaluate interest in environment and response to parent - infant who does not have interest in the environment or seems unable to recognize their parent is concerning - infant who enjoys sucking a finger and making eye contact with the nurse during assessment is reassuring

How to administer adenosine

FAST IV push followed by rapid generous saline flush - rapid onset and extremely short half-life

Focus of palliative care

Pain and discomfort

What is circumoral pallor an indication of?

Poor oxygenation

The nurse is caring for a school-age child with cerebral palsy. Which of the following developmental tasks, appropriate for this age, may be delayed? • a. Attachment to family b. Sense of independence c. Achieving industry d. Forming a sense of identity

c. Achieving industry

Monogenic disorders (Mendelian)

- autonomsal dominant/recessive - x-linked dominant or recessive

Major burn areas

- face - hands - feet - perineum - any joint area

Poison control center hotline number

1-800-222-1222

A parent asks why a physical therapist is needed for the 6-month-old child diagnosed with Down syndrome. What is the best response by the nurse? "To optimize the child's development and functioning" "The earlier the intervention, the more likely we are to cure the problem" "To prevent contractures" "To ensure that the child meets all developmental milestones on time"

"To optimize the child's development and functioning"

Characteristics of sexual abusers

Male that victim knows

Behavioral indicators of neglect

- begs or steals food - attends school inconsistently - arrives early or stays late after school - constantly fatigued - unable to relate well to adults - difficulty forming relationships

Parent behavior that indicates sexual abuse

- blames the child for abuse - accesses and views child porn

What should hot waters be set at the prevent burns?

<120 degrees

Classic physical appearance of Down Syndrome

- brushfield sports (white spots) on irises - extra space between the first and second toes on both feet - almond shaped eyes - flattened facial profiles - hypotonia (evidence in child's posture) - joint hyper-flexibility - short and broad hands, with single crease on the palm - short neck - slight upward tilt in eyes - tongue that sticks out most of the time

Multifactorial genetic disorders

- cleft lip and palate - spina bifida - pyloric stenosis - congenital hip dysplasia - clubfoot - cardiac defects

Long term risks for premature baby

- cognitive delays - visual impairment, chronic lung disease - cerebral palsy - attention deficit disorder - learning disabilities - difficulties with socialization - vulnerable child syndome - alterations in muscle tone

Cause of cardiopulmonary arrest in children

Most likely from respiratory failure

Examples of autosomal recessive genetic disorders

- cystic fibrosis - PKU - tay-sachs - sickle cell disease

ventricular tachycardia

Rare and associated with congenital or acquired cardiac abnormality

Teaching points during transition of adolescent to adult care

- diagnosis and medical history to date - treatment rationale - symptoms of worsening condition - danger signs - when to seek help from professional - medical insurance process - detailed written plan of care - consultation with transition services coordinator

The clinic nurse talks with the parent of a child with Down syndrome. The parent states, "I thought my 1-year-old would be walking by now. I am concerned." What response by the nurse is best? "Milestones are often delayed for children with Down Syndrome." "How many other children do you and your husband have?" "How old was your child when he or she first begin to smile?" "We should ask a physical therapist to address your concern."

"Milestones are often delayed for children with Down Syndrome."

Multifactorial

Caused by multiple gene and environmental factors

Trisomies

3 copies of a chromosome - most common include trisomy 21 (down syndrome), trisomy 18, and trisomy 13

Five B's of physical abuse

Bruises Burns Bones Bellies Brains (bathroom)

Bradyarrhythamis

Life threatening when HR is <60 (not in adolescents) - can result in hypoxia and shock - sustained bradycardia is associated with arrest and should be taken seriously Epinephrine can be used

Factititious disorder

Munchausen syndrome by proxy - caregiver fabricates symptoms or induces symptoms to get attention from medical providers - child may undergo needless and painful procedures

Monosomies

Only one copy of particular chromosome instead of usual pair - all fetuses spontaneously abort in early pregnancy

Vulnerable child syndrome

Parents perceive the child as especially susceptible to illness or injury. Usually follows a serious illness or life-threatening event. Can result in missed school or overuse of medical services.

Which step would be the priority in assisting parents with coping with the news of their child's chronic diagnosis? 1. Help parents gaining a working knowledge of the disorder 2. Informing parents about available resources and support groups 3. Allowing parents to experience shock and denial 4. Assuring parents that help is available to assist them to inform their child and other family

3. Allowing parents to experience shock and denial

CPR for child with 1 person

30 compressions to 2 breaths Hand placement: heel of the hand or two hands for older children, pressing on the sterum at nipple line

CPR for infant with one person

30 compressions to 2 breaths Hand placement: two fingers placed one fingerbreadth below nipple line

Pulses in children

Carotid and femoral pulses are the easiest to asses

Neglect

Continued failure to provide child with necessary care and protection including adequate shelter, clothing, medical care, dental care, and education - failure to meet child's need for affection, attention, or emotional nurturance - deliberate attempts to destroy or impair child's self esteem or competence

Chromosomal

Does not follow straightforward pattern of inheritence - can be structural or numerical abnormalities

Secondary prevention of cognitive impairment

Early identification to initiate treatment to avert damage - prenatal diagnosis or carrier detection - newborn screening tests

What are low set ears indicative of?

Genetic disorder or renal impairment

Cardiac complications in children

Slow: bradyarrhythmia Fast: tachyarrhythmias Absent: pulseless, cardiovascular collapse

The nurse is caring for a family making end-of-life decisions for their child. How will the nurse educate the parents as to what is involved in end-of-life care? The focus of care will be on the comfort of the child. The staff will complete care when parents request. The parents will be able to do complete care for child. The child will be placed in hospice so the child is not alone.

The focus of care will be on the comfort of the child.

A hospitalized child has suddenly stopped breathing. The nurse opens the child's airway and assesses the child's pulse. The nurse will begin cardiopulmonary resuscitation (CPR) when which symptom is present? The heart rate is 60 beats/min or lower. There is no respiratory effort. The respiratory rate is 8 breaths/min. The airway is not patent.

The heart rate is 60 beats/min or lower.

5 categoris of child abuse

- physical abuse - sexual - emotional - neglect - sex trafficking

Risk factors for vulnerable child syndrome

- preterm birth - congenital anomaly - newborn jaundice - handicapping condition - accident or illness that the child was not expected to recover from - crying or feeding problems in the first 5 years of life

Initial nursing management for burns

- stop the burning process - assess victim condition - cover burn - transport to medical aid - provide reassurance - management of minor burns - tetanus

Signs of abuse with burns

- inconsistent history - delay in seeking treatment by caregiver - uniform appearance of burn - for scald burn, lack of spattering of water - stocking/glove pattern on the hands and feet - flexor sparing burns

Primary prevention of cognitive impairment

- maternal immunizations - genetic counseling - folic acid supplements - education: dangers of smoking and alcohol during pregnancy - reduction of head injuries - future gene therapy

Examples of autosomal dominant genetic disorders

- neurofibromatosis - huntington disease - anchondroplasia - polycytstic kidney disease

Parent behavioral indicators of physical abuse

- overly critical of child's behavior - no physical or emotional support when child is injured or in pain

Shock

Inability for blood flow and oxygen delivery to meet metabolic demands of tissue - if left untreated cardiopulmonary arrest will result Can be compensated or uncompensated

Uncompensated shock

Inadequate perfusion accompanied by drop in BP - can lead to cardiac arrest and death

A group of students are reviewing information about respiratory arrest in children. The students demonstrate understanding of this information when they identify what common causes of respiratory arrest involving the upper airway? Select all that apply. a.) pertussis b.) epiglottitis c.) pneumothorax d.) croup e.) asthma

b.) epiglottitis d.) croup

A client asks about a child inheriting an autosomal recessive disorder. What must occur for an offspring to demonstrate signs and symptoms of the disorder with this type of inheritance? a.) One parent must have the disease. b.) Both parents must be carriers. c.) One parent, usually the mother, must be a carrier. d.) One parent, usually the father, must not be a carrier or have the disease.

b.) Both parents must be carriers.

During a home visit, a nurse determines that a child is experiencing psychological maltreatment based on which action by the parent? a.) The child is asked to play a song on the piano for the nurse. b.) The child is belittled in front of the nurse and older brother. c.) The child is punished for crossing the street without assistance. d.) The child is scolded for playing with matches.

b.) The child is belittled in front of the nurse and older brother

The nurse is caring for a family making end-of-life decisions for their child. How will the nurse educate the parents as to what is involved in end-of-life care? a.) The staff will complete care when parents request. b.) The focus of care will be on the comfort of the child. c.) The parents will be able to do complete care for child. d.) The child will be placed in hospice so the child is not alone.

b.) The focus of care will be on the comfort of the child.

The nurse is teaching the mother of a toddler about burn prevention. Which response by the mother indicates a need for further teaching? a.) "The handles of pots on the stove should face inward." b.) "We will leave fireworks displays to the professionals." c.) "All sleepwear should be flame retardant." d.) "I will set our water heater at 130°F (54°C)."

d.) "I will set our water heater at 130°F (54°C)."

Upon assessment, the nurse notices that the infant's ears are low-set. What is the priority action by the nurse? a.) Inform the parents that low-set ears are a sign of Down syndrome. b.) Give a vitamin B12 injection to combat the metabolic disorder. c.) Place the infant on a cardiac monitor. d.) Continue to assess the infant to look for other abnormalities.

d.) Continue to assess the infant to look for other abnormalities.

A hospitalized child has suddenly stopped breathing. The nurse opens the child's airway and assesses the child's pulse. The nurse will begin cardiopulmonary resuscitation (CPR) when which symptom is present? a.) The airway is not patent. b.) The respiratory rate is 8 breaths/min. c.) There is no respiratory effort. d.) The heart rate is 60 beats/min or lower.

d.) The heart rate is 60 beats/min or lower.

The nurse has administered IV adenosine as prescribed to a child with supraventricular tachycardia. Which action would the nurse do next? Set up a continuous infusion for administration of adenosine. Monitor for ventricular arrhythmias. Administer a rapid, generous saline flush. Give five positive-pressure ventilations.

Administer a rapid, generous saline flush.

Questions to ask when child has suspected toxic ingestion

-Approximate time of poisoning -Nature of the toxin -How was the toxin ingested (inhaled, applied to skin, etc) -Does the caregivers have the medication bottle -Did the child experience nausea, vomiting, anorexia, abdominal pain, or neurologic changes -Determine progression of symptoms - Did parents call poison control?

Which statement by the parent of a 5-year-old child with special needs indicates to the nurse additional teaching is needed? "I hope my child will be toilet trained soon. We are working on it." "My child has an imaginary playmate who has a place at our dinner table." "I do not take my child to the park when other kids are there because they tend to stare." "My child enjoys knocking down tall block towers I build."

"I do not take my child to the park when other kids are there because they tend to stare."

The nurse is working with a family as they make decisions regarding their newborn's care following the diagnosis of a serious genetic disorder. What response by the nurse would be appropriate? "Are you sure your doctor has enough experience to help you care for your child?" "My niece has the same disorder so I can tell you what I think you should do about it." "Requesting input from your extended family will likely complicate your ability to make decisions." "What are some advantages and disadvantages of the decisions you are making for the baby?"

"What are some advantages and disadvantages of the decisions you are making for the baby?"

The parents of a premature newborn are adjusting to the fragile state of their newborn. Which response by the nurse will assist the most in this transition? "I think the name you picked for your baby is the cutest name in the whole nursery." "I will keep changing her diapers until you feel you are ready to be good parents to her." "You are doing great holding her with all her equipment. Do you have any questions?" "Your baby looks so much like you. I see your eyes and your smile in her."

"You are doing great holding her with all her equipment. Do you have any questions?"

Child physical indicators of sexual abuse

- difficulty walking or sitting - torn or stained underclothing - complaints of pain, swelling, or itching of genitalia - pain with voiding - injury to genitals - STI - pregnancy

Organ donations

- discussion is separate from impending death or brain death notification - written consent is necessary - all expenses are borne by recipients family - state that the child's appearance will not be marred - donating child will not suffer - family and culture spiritial beliefs must be considered

Signs and symptoms of physical abuse

- unexplained injuries specifically on the eyes, mouth, back, thighs, butt, genital areas - repeated injuries - fractres at different stages of healing - subdural or subarachnoid hemorrhage - missing patches of hair - ETOH or drugs in system - exhibiting signs of self-destructive behaviors

Parent behavioral indicators of neglect

- unresponsive when child's appearance is discussed - fails to take the child to HCP for necessary care - fails to give child medications - fails to provide safe place to reside - fails to require school attendance - leaves child unattended

Adjusted age equation

1 month = 4.5 weeks Actual age - weeks premature = adjusted age - use adjusted age for immunizations and health promotion

Submersion injury

2nd leading cause of preventable death in children and adolescents - lapse of adult supervision is the single most contributing cause - aspiration leads to poor oxygenation and pulmonary edema - survivors are at risk for renal complications

CPR for child with 2 people

15 compressions to 2 breaths Hand placement: heel of the hand or two hands for older children, pressing on the sterum at nipple line

CPR for infant with 2 people

15 compressions to 2 breaths Hand placement: two thumbs encircling the chest at the nipple line

When was the first case of child maltreatment

1874

SVT

Common cause is re-entry problem in cardiac conduction system - associated with caffeine - infants >220 - children >180 - no variability! - can be compensated or uncompensated

Tachyarrhythmias

Fever, fear, pain are common explanations - focus on underlying cause. - inappropriate to treat sinus tachy with medications SVT

After interviewing the mother of a newborn and observing her actions, the nurse suspects that the newborn may be at risk for maltreatment. Which assessment finding would support the nurse's suspicion? a.) Mother helps to undress the newborn for the physical examination. b.) Mother quickly changes a dirty diaper using supplies from her diaper bag. c.) Mother fails to make eye contact with the newborn throughout the interview. d.) Mother reports that the father helps with feedings during the night.

c.) Mother fails to make eye contact with the newborn throughout the interview.

The parents bring their 3-year-old child to the emergency department after ingesting some of the parent's morphine liquid prescription. Which nursing assessment is the priority? a.) auscultating all lung fields for signs of edema b.) obtaining a complete set of vital signs c.) evaluating the child's mental status, skin moisture, and skin color d.) noting the child's pulse rate and quality

c.) evaluating the child's mental status, skin moisture, and skin color